Tucson’s Arizona Daily Star recently ran an op-ed by a pediatrician, Dr. Kevin Dveirin, who is very upset about President Bush’s proposed new rules requiring states to enroll 95 percent of poor kids in state children’s health insurance programs before signing up middle income kids. And he makes an apparently reasonable case. Or does he?

According to Doctor Dveirin, “A recent study of Arizona children reported in the journal Pediatrics showed that for every 1,000 children enrolled in AHCCCS (the state Medicaid program) and KidsCare, there were 300 fewer ER visits and 1,000 fewer hospital days per year. This resulted in a communitywide medical-cost savings of more than $2,000 per year per child enrolled.”

Dr. Dveirin kindly provided me the precise reference, which reads a little different than the op-ed. Rather than discussing an actual change in policy, the article reports a simulation, whereby the researchers looked at the behavior of currently uninsured kids in Phoenix, AZ, compared it to kids enrolled in KidsCare (Arizona’s Medicaid/SCHIP expansion) and used high-falutin’ statistical methods to determine what would happen if 10 percent of the KidsCare kids became uninsured.

The conclusion? They would be less likely to see primary care physicians, resulting in delayed care, increased ER use, and avoidable hospital admissions. So, Dr. Dveirin’s statement certainly maintains the spirit and numbers of the conclusions – but they are modeled projections, not historical fact.

Further, the article makes (at least) one stated and one unstated assumption that tremble under scrutiny.

First, they assume that all of the kids who leave KidsCare become uninsured, despite citing Cunningham, who figured that, because some ex-SCHIPers would become privately insured, ER visits would not increase. Further, Gruber concludes that 60 percent of SCHIP enrolment comes from crowding kids out of private health insurance. So, it is quite unrealistic for the Arizona authors to model zero return to private insurance.

Second, because of federal EMTALA (Emergency Treatment and Active Labor Act) and state laws to prevent “patient-dumping” (which have likely failed, but that is for another post), ER care is “free”. There is little incentive for families with kids who are otherwise healthy, but might perhaps suffer an acute illness, to demand effective and low-cost private health insurance. If the kid ends up in the ER, and perhaps even admitted, the hospital will send the bill to the government in any case (with a lot of flailing and screaming about “uncompensated care”), whether he’s enrolled in government health care or not.

So, Arizonans need not be afraid that a fiscally disciplined KidsCare program will send hordes of kids into their ERs – especially if they can convince their legislators to reform hospital regulation and payment, too!